Treatment of Discoid Skin Lesions With Azathioprine-Reply

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In Reply.—We agree with Drs Werth and Franks that less toxic modes of therapy than azathioprine sodium should be considered first in patients with systemic lupus erythematosus (SLE) and extensive skin lesions. It is also our experience that most patients with lupus skin lesions respond well to treatment with either hydroxychloroquine sulfate or chloroquine at the recommended dosages. Obviously, treatment with a single antimalarial1-3 has fewer potential side effects than treatment with azathioprine.4 Though the clinical experience of Drs Werth and Franks and others1 would suggest that combined usage of hydroxychloroquine and atabrine at appropriate dosages as a mode of therapy is effective and safe in recalcitrant cutaneous lupus, data concerning either the efficacy or the toxicity of this recommended combined mode of therapy are not available in the literature cited1,3 or elsewhere, to our knowledge. If, indeed, therapy with hydroxychloroquine and atabrine combined are